Data Operations Analyst

August 7

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The End-to-End Platform for Risk Adjustment, Quality Improvement, and Member Management

51 - 200

Description

• Ensure accuracy and completeness of data submissions to CMS • Provide reports and analysis specific to the encounter data submissions to CMS • Identify root cause of data loss and encounter rejections and co-ordinate with internal teams to enable complete and accurate submissions • Work with other teams to verify, test and correct error within the encounter data system • Monitor and track encounter data throughout the process and ensure data integrity through ongoing end-to-end reconciliation • Must be able to perform UAT and setup best practices for the function • Participate in cross-team encounter data workgroup meetings • Analyze trends and create documentation supporting all reports • Track CMS timelines for submissions and work with internal teams to meet the deadlines • Maintain thorough documentation of RCAs and be able to train other members on team

Requirements

• Minimum 5 years of healthcare data management in areas of Claims Processing, Submissions, Rev Recon, Quality and Hedis • Strong understanding of Medicare Programs • Minimum 5 years’ experience working with Medicare Encounter Data and Risk adjustment Methodology • In-depth knowledge and experience of SQL and any standard ETL tool • Strong Knowledge of X12 EDI files • Knowledge of ICD10 codes, CPT/HCPCS, revenue codes, UB04 and CMS1500 claim submissions and electronic claim submissions • Ability to independently gather, interpret and analyze data • Ability to extract data from multiple source using software tools • Ability to understand, interpret, create, execute complex queries and reports • Excellent written and verbal communication skills

Benefits

• Competitive salary • Medical, Dental and Vision benefits • 401k with Employer Match • Generous PTO plan